Download Hygiene is an important preventive measure for cellulitis. Breaks in

ADIRONDOC
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Hygiene is an
Today's topic is a reminder of a couple of important facts. First, we all
live in a veritable cesspool of bacteria, covering every inch of our body and
most surfaces we touch. Fortunately, healthy folks seem to have no difficulty
with this. Second, some seemingly minor health issues can simply be
"watched" in civilization, but in the backcountry must be taken very seriously.
Skin infections go by a variety of names, but for simplicity we will classify them
as abscesses and cellulitis. Abscesses
are more localized. They can be
thought of as walled-off collections
of pus, which sometimes drain spontaneously. Often, drainage is all that
is required to treat an abscess.
Cellulitis is a bit more complicated,
and potentially much more serious.
These are infections under the skin
tha spread throughout tissues, sometimes with dramatic speed. They are
not localized like abscesses, and
therefore there is nothing to drain.
Cellulitis generally begins with a
small break in the skin, which allows
bacteria to enter. Rarely, the infection
may be blood-borne and not associated with any obvious breach in the
skin. The first sign of the infection is
an area of redness that is often quite
tender, warm, and hard to the touch.
Most often, our body's intricate
defense mechanisms fight off the
infection, and it gradually recedes on
its own.
Here is where the approach to
possible cellulitis in the backcountry
differs from home. When care by
one's physician or urgent care center
is a few moments away, watchful
waiting may be appropriate. The last
time I visited, however, there was no
urgent care center in the Five Ponds
Wilderness! Waiting too long in the
wilderness could be a prescription
for disaster.
Some findings with cellulitis demand immediate exit from the backcountry. Anyone who has fever,
chills, or other "systemic" symptoms
associated with a skin infection
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Adirondac
needs to get to definitive care rapidly.
What seems like a trivial skin infection at one point can progress to
overwhelming disease and organ
failure within hours.
Another warning sign is the presence of streaks of redness extending
from the local infection upward
toward the center of the body. This is
evidence that the infection is entering the body's lymph system.
Does this mean that anyone with
a little skin redness needs to hike out
immediately? Of course not. It
means that the individual merits
close watching. One very useful technique is to use a pen to outline the
margins of redness. Cellulitis that is
moving beyond its inked boundary
every few hours probably merits an
end to the trek If the individual is
otherwise feeling well, and the lesion
is not spreading, continued careful
watching is appropriate.
As with many wilderness problems, hygiene is an important preventive measure for cellulitis. Breaks
in the skin should be washed with
soap and water, and protected with
an over-the-counter antibiotic ointment. Once an infection is established, however, such ointments
have no value.
There is little first aid for cellulitis.
Warm compresses increase the flow
of infection-fighting blood cells, but
this is rarely practical in a campsite.
Definitive treatment requires oral or
intravenous antibiotics. I am not a
proponent of non-professionals
bringing prescription medications
important preventive
measure for cellulitis.
Breaks in the skin
should be washed
with soap and water,
and protected with an
over-the-counter
antibiotic ointment.
into the wilderness. However, folks
entering areas from which medical
care is a day or two away may wish to
consult with their personal physician
about bringing an appropriate drug
with them. If this is done, remember
that the antibiotic is only to be used
during evacuation, not to replace it.
~
Tom Welch, MD, is professor and chair
of pediatrics at Upstate Medical
University in Syracuse and an active
member of the Wilderness Medical
Society. He is a licensed professional
guide and certifying instructor for the
Wilderness Education Association, and
has guided groups in the Adirondacks,
Montana, 4nd Alaska. More information is available at his website and
blog: www.adirondoc.com. Infectious
disease specialist Jana Shaw, MD,
MPH, reviewed this column and provided helpful comments.